Proof of concept of a self-administered digital health screener (SASH) to increase reporting of unhealthy alcohol use by persons with HIV in care in Uganda

Abstract Alcohol consumption is a critical driver of the HIV epidemic in sub-Saharan Africa. Among those with HIV, alcohol consumption has consistently been associated with reduced antiretroviral adherence crucial for treatment as prevention. Thus, reducing alcohol use among those with HIV is a high priority. Brief interventions to reduce alcohol use (ABI) have been efficacious in primary care in developed countries. However, the usefulness of ABIs depends on effective screening for unhealthy alcohol use. Using phosphatidylethanol (PEth), a sensitive and specific biomarker of recent alcohol use, we have repeatedly found under-reporting by persons in HIV care in Uganda. For example, 50% of a sample of drinkers starting ART denied any alcohol use. Thus, there is an urgent need to develop methods to improve reporting of unhealthy alcohol use. The objective of this study is to develop and pilot a brief (3-5 minute) self-administered digital health screener (SASH) to increase the reporting of unhealthy alcohol consumption among those in HIV care in Uganda. We hypothesize that brief questions on alcohol use embedded in a general health screener, self-administered in an HIV clinic waiting area, can improve reporting of unhealthy alcohol use. The rationale is that Audio ComputerAssisted Self Interviewing (ACASI) has been successful in increasing reporting of sensitive behaviors. In addition, there has been an upsurge of mobile device use worldwide, and the simplicity of touch-screen devices will facilitate use by low-literacy populations. Thus, SASH may provide increased detection of unhealthy alcohol use as an essential first step towards referral to alcohol interventions. This study has the potential to have a large health impact, because a SASH may efficiently and sensitively screen for health issues in addition to alcohol use, such as smoking, depression, and medication adherence, leading to improved referral and treatment for several health problems.